Questions from the floor to the Hon Jillian Skinner MP, Minister for Health, Minister for Medical Research, at the NSWNMA Annual Conference on Friday 9 August, 2013.

Luke Marks

Luke Marks, Orange Base Hospital branch:
Minister, we all know that NSW is currently not meeting the NEAT [National Emergency Access Target] targets within the emergency department. A couple of the strategies you have spoken about today which will be implemented will definitely help a bit of that but one of the reasons is there is a lack of sufficient mandated staffing levels. Why won‘t you, Minister, agree to support guaranteed award-based staffing levels for emergency departments? This would go a long way in improving patient outcomes and safe patient care.

Minister:
As I said in my speech, I have a very high regard for those nurses who work in our emergency departments…but can I tell you that one of the issues regarding nursing in emergency departments is the dynamic situation confronting you on a daily basis, and that’s why it’s considered that a more flexible arrangement, leaving it up to the hospital staffing arrangements, would better suit the needs of your emergency department. I believe that some of the initiatives that I have announced today will help that, but there is a mechanism to address the increased demand in emergency departments from a day-to-day, hour-to-hour, minute-by-minute arrangement [which] is better addressed by the more flexible workloads pattern arrangements that are made at the hospital level.

Lyn Hopper

Lyn Hopper, Manly Hospital branch and Council:
Minister, you are a senior Liberal and a senior Liberal politician in health so I am sure you are aware of what’s going on in NSW and Australia as far as health goes. You would be aware that back in April, Mr Dutton, your federal counterpart, was reported in various business newspapers and magazines advocating the privatisation of public health. … I read his quote “the Coalition, if we are elected, would continue to work with state governments that have delivered services through private hospitals and not-for-profits.” This is surely what this really means – it is privatisation of public health. In the heat of an election, Mr Dutton is now running around trying to deny all this. Given this has major implications for the state hospitals and I am sure, in particular, that you know the Northern Beaches problems, and as a senior health politician in Mr Dutton’s party, are you aware of him or anyone in the Federal Opposition or the Liberal Party denying these comments or having these statements corrected at any time? And, if they are elected in September, will you work with Mr Dutton and Mr Abbott to continue to privatise more hospitals in NSW?

Minister:
I can’t answer for Mr Dutton’s comment – you claim that he has denied it. I can only say that I would expect that he would be truthful in that case, so he’s certainly not discussing anything with me about involvement of the private sector in any of our public hospitals. In fact, I have no intention at this stage of doing anything like that. The new Northern Beaches Hospital is just that – it’s a brand new hospital on a brand new greenfields site, it will provide public patient care in a greater number and capacities than the two hospitals that it replaces. There has been widespread support for it involving both the private sector and the public sector; it will be part of Northern Sydney Local Health District clinical service planning and the staff who are working both at Manly and Mona Vale have all been guaranteed that they will have jobs. Lyn, I know your background in relation to your complaints about the Coalition on the Northern Beaches, but the truth of the matter is people have welcomed this hospital – nurses, many of them, the clinicians – and there has been widespread support for it.

Lyn Hopper:
I disagree with the widespread support for it Minister – I think you’ll find there’s widespread support not for the private hospital. We are very happy for a new Level 5 public hospital, but the last thing we need on the Northern Beaches is more private beds.

Minister:
There are no private beds to speak of on the northern beaches…

Lyn Hopper:
… In the Northern Sydney Local Health District, we actually have the highest percentage of private beds in the whole of the state: 45% of the beds in the NSLHD are private, that is the highest amount of private beds in the whole of the state so the last thing we need on the Northern Beaches is more private beds.

Minister:
Can I just explain to people that the people of the Northern Beaches do not have direct access to a private hospital. In fact, 40% of those treated in the public hospitals at Manly and Mona Vale were being treated as private hospital patients. So this is a way of freeing up some of those beds that were currently being occupied by private patients now for public patients.

Fiona Deegan

Fiona Deegan, Mona Vale Hospital branch:
Can you, Minister, guarantee a private operator of your proposed new Northern Beaches Hospital will have the same nursing hours system applied in the same way as existing public hospitals of the same Peer Group and ward types, not for two to five years, but forever?

Minister:
The outline of our commitment to staffing was made at the announcement of the expressions of interest request and that would be that we would require the new operator to offer employment to the existing staff on their current positions without interview for a period of five years with all award and salary provisions in act.

Gary Clark

Gary Clark, Justice Health Nursing Managers Statewide branch:
Firstly, I’d just like to thank you for your sponsorship for me for the Public Service Management Program… The first assignment we were given…was about politics and the public sector. I did an article search and I came up with an article from the ABC on 24 July…we will probably all remember that day because it was the nurses’ strike day – in it they quote the government and the Health Minister unfortunately as saying the strike was ludicrous as the union had not told or informed the nurses of NSW about the pay increase and this required two half-page ads to be placed in the metropolitan papers. Minister, I know that this Association has sent podcasts and numerous information out to all of its members. …I have ten articles here prior to that date from the Association clearly outlining the pay offer. Now Minister, if I or any of my staff make a mistake, the first thing we do is we apologise, we apologise to the patient, we apologise to the relatives, we apologise to everyone. So my question for you Minister is will you request…ask your advisers to apologise to the elected officials of the NSW Nurses and Midwives’ Association for the misinformation to the public of NSW.

Minister:
…I can tell you that many of the nurses that I have spoken to were unaware that a submission was lodged on May 15 offering 2.5% to include the 0.25% superannuation…a number of them did not know that. So I won’t apologise but can I say that if apologies are called for, for misleading in an advertisement, then I might ask about the advertisement claiming that we are going to privatise, against a photograph of Liverpool Hospital, this week.

Debbie Lang

Debbie Lang, Gosford Private Hospital branch:
…Minister, I am a Councillor and member of QACAG – Quality Aged Care Action Group – and proud of being in the private sector and supporting the public and everyone else. Minister, do you believe that a registered nurse should at all times be present in a nursing home in NSW as according to the current legislation?

Minister:
I believe the legislation should be upheld and if there is a problem with that, then let me know. But you understand that nursing homes are largely Commonwealth, although the registration of them falls under the state. But I would be happy to take that on board.

Debbie Lang:
The residential care owners are currently agitating and protesting and are trying to remove the presence of a registered nurse and their 24-hour clinical oversight of aged, frail people in residential care.

Minister:
I regard that as a great pity because some of the most exciting programs I have seen are ones where aged care residential facilities are working very closely with hospitals and I cite for example the Grace Program run out of Hornsby and the Geriatric Flying Squad at Sutherland… the work that they are doing in conjunction with those senior nurses in the aged care facilities to keep their patients or their residents there instead of calling for an ambulance when it was totally inappropriate for the wellbeing of the patient. It is something I feel very strongly about…

Debbie Lang:
The clinical oversight of those registered nurses for preventing patients’ admissions to hospital and their ongoing quality of life by maintaining their regular daily maintenance through nutrition, clinical oversight with their wound care and everything else is vitally important. Both my parents are 90, one has been in aged care nine years; a lady at my father’s table is 101, there’s a lot of places on the Central Coast, there are a lot of people over 100. Our population is ageing and it’s critically important that the residential care owners realise clinical registered nurses need to be present in nursing homes at all times.

Karen Fernance

Karen Fernance, Bankstown Hospital branch:
Ms Skinner, can you give us assurances that services that should be supplied by our government will not be privatised? And what happens to the local community when the private partners are just not interested, like at Bankstown wanting a cath lab?

Minister:
Watch this space in relation to the cath lab because the cardiologist raised it with me personally and I have taken it up. In most of the cases where there has been private sector involvement in hospital services, and I am thinking particularly of the imaging services I discovered recently at Port Macquarie that’s being extended to the network of hospitals there, it’s providing a very high quality, much respected service. I can’t imagine they would pull back from that, but in the event they did, they would be picked up again by the public sector because it was such a critical issue to the wellbeing of patients. I understand that.

Karen Fernance:
But we are talking about any new enhancements or any new services that may be developed down the line, and in particular I am talking about Bankstown’s cath lab, but Stage III of Liverpool’s one more cath lab – can you give assurances that they won’t be privatised?

Minister:
No, because I have not considered that at all. There are…other services within facilities that are working extremely well and they are a combination of private and public sector.

O’Bray Smith

O’Bray Smith, Royal Prince Alfred Hospital branch and Councillor:
Minister, are you aware of the rogue behaviours that the NSW leaders of AHPRA are forking out to our registered nurses and midwives at the moment? At RPAH this month we have had a registered midwife/registered nurse de-registered as an RN because her job title says she’s a midwife and so she doesn’t have any recency of practice for nursing. A disgrace in the fact that she did three years at uni to get her RNs, she works on the ward, she gives IV antibiotics, she looks after post-op women, etc etc using her nursing skills, however AHPRA have just de-registered her as an RN. Minister, in your speech you give out a lot of figures; in 2015 how are your figures going to look if a lot of nurses and midwives are de-registered?

Minister:
You will be interested maybe to know that concerns about AHPRA, particularly in its early days, have been a constant agenda item at the Health Ministers Council…as well as at the most recent one, and I will take that up if you wish to speak to me or my staff later. It is certainly not something that I would support but you understand that this is a national registration process that the Nursing and Midwifery Board is involved in so I have to go through that channel.

O’Bray Smith:
I understand it’s a national process, but you’re our Minister in NSW and it’s happening in NSW, not in other states, so it is very much an issue for us.

Minister:
Yes I understand which is why I will take it up. But you understand that I have not got the power to change it. You might be interested to know the longest speech I ever made in parliament was when the former government introduced this national registration which is a weird system where the legislation actually stems from a Queensland government and to amend anything, we have to all go to Queensland and get them to amend their legislation. So, it’s a really problematic process – I fought against it at the time and you might see some changes in the near future if all the states can agree. But I will certainly guarantee to take it up because you’re right, I am the State Minister and it’s going to affect our capacity to deliver care in our hospitals.

Sheryn Garner, Mount Druitt Hospital branch:
It’s to do with our after-hours service that you directed. Due to safety, security and staffing concerns, the Western Sydney LHD correctly decided to reduce home visits out of hours, in part due to lack of funding. Is it true that in response to a phone call or letter from Alan Jones [2GB radio broadcaster] you have now directed the service to recommence. This will mean: (1) nurses being placed in unsafe situations in the middle of the night with no security; (2) nurses being forced to work excessive and unreasonable overtime, and (3) patients receive a second-rate service. Award ratios are working but the on-call home visit service is not and must receive additional funding and staff or must cease. My question is, why would you direct an unsafe, under-funded, under-staffed service to re-open?

Minister:
In a devolved process of health, I am not directing anyone to do anything. I did ask for this matter to be looked into when I received a complaint which stemmed from a nurse I am told … about not being able to deliver the care. Now, it was said that that could be continued to be provided but I understand there is very little call for after-hours palliative care nursing in the home so there hasn’t been a huge demand for it. You should also know that I put out a palliative care plan last year; as part of that we announced additional funding for community-based palliative care and the announcement about how that money will be disbursed will be made I believe in early September, so within a couple of weeks.

Sheryn Garner:
In response to that, our DoN actually gave us a letter two days ago stating that we must, we have to reinstate that service as of 4.00pm Thursday afternoon.

Minister:
Well you need to go and speak to your Local Health District about that – I didn’t write a memo saying it must be reinstated.

Michelle Nicholson

Michelle Nicholson, Liverpool Hospital branch:
Our award requires replacement of absences with like-for-like classifications, example RNs with RNs, but this isn’t happening Minister. RNs and ENs are consistently replaced with AiNs, even when RNs and ENs are being refused casual shifts. South Western Sydney LHD is developed and finely tuned to meet the specific needs of those particular units so when RNs and ENs are replaced with AiNs and unqualified staff, which happens daily, not only is the award breached, patient care is significantly compromised. Minister, what will you do about this?

Minister:
Award conditions and agreements are supposed to be implemented so it is something I will raise with the Nursing and Midwifery Office in the Ministry, but as far as I am concerned, there are local mechanisms to ensure that those things are dealt with. But I am sure it’s the kind of thing that Brett will be in conversation with the Ministry as he is discussing the conditions and matters that are onging.

Lynda Binskin, Port Macquarie Base Hospital branch:
Minister, will you and the Ministry of Health undertake to quote actual full-time equivalent positions in future when describing the increase in the numbers of new midwives and nurses. Many members feel betrayed and taken as mugs when the figure of 4,000 was thrown around. It is quite ingenious (sic) to use that figure when in fact it was nowhere near that number.

Minister:
It’s 2,700 equivalent full-time and I say it all the time – the media don’t report it all the time…

Lynda Binskin:
It would help if you quote 2,700 first rather than throwing 4,000 out there.

Minister:
I am just following the practice of the former government – it was in the former Minister’s press release.

Lynda Binskin:
And if you could please direct the Ministry of Health to do the same, that would be lovely.

Minister:
Thank you – I think we do quote both figures, they don’t always get picked up though.

Helen Norris

Helen Norris, Dunedoo Hospital branch:
You’ve stated that you are for safe patient care – I am from the Western NSW Local Health District, I was wondering why we are going to lose 2.2 full-time equivalents when we run minimum staffing anyway.

Minister:
I can’t answer that question, I will have to take it on notice. I am not aware of that at all sorry.

David Pfanner, John Hunter Hospital branch:
On 31 March, John Hunter operating theatre peri-operative services allocated seven FTEs as part of the enhancement for the ACORN 2008 Standards. The Local Health District received the money for those positions in early March 2013; five months down the track we are advised they have not recruited these positions. Minister Skinner, where is the money now and why haven’t the nurses been recruited? Arrangements have been made by the senior staff members to get agency staff – they’re not being used and we are still running 10 operating theatres every single day.

Minister:
That’s another one where the Local Health District has total responsibility but I am very happy to look into it for you.

David Pfanner:
Another quick thing: we had a lady leave recently who gave 22 years of service to John Hunter Hospital of running theatres and she walked out of the theatres and was almost in tears in the change room – she wasn’t thanked in any way by the senior management.

Minister:
That is a shame.

Kerry Rodgers, Nepean Hospital Penrith branch and Council:
Minister I would like to ask you the same question that I asked you at the recent Penrith Community Cabinet meeting and you failed to answer my question. And that is, when will you and your government negotiate in good faith with the Nurses and Midwives’ Association of NSW around cementing the ratios that have already been won and extending those ratios across the state and providing equity of ratios to those smaller Peer Group B and C hospitals who are caring for the same patients as those larger hospitals. And, I am sure that the community health and the community mental health nurses will be very happy that they are getting some CSO positions but they need nursing positions, the ratios need to be extended into those areas.

Minister:
As I said at Penrith, I take exception to the claim that the Ministry is not in negotiation with the union. Brett, do you meet regularly with the…?

Kerry Rodgers:
A discussion is not a negotiation Minister.

Minister:
I am just trying to clarify this – there is a regular ongoing meeting between the union and the Ministry to discuss this and all workforce matters.

Brett Holmes, General Secretary:
Minister, I am happy to assure you that I have discussed with the delegates the fact that we are having what we call discussions; we haven’t had negotiations in this agreement because the government set the parameters around what it thought was negotiations, ie that’s the wage cost, that’s the wage outcome and nothing more can be done to extend anything beyond that unless nurses pay for it themselves. So the discussions we’ve had have obviously been listened to by the Ministry of Health and I am very glad to hear that a number of the things that were discussed with us have resulted in announcements today. But I think there is a very clear definition between being in real discussions or negotiations around award matters and having discussions that are outside the parameters of award negotiations.

Minister:
That’s confirmation that it depends on whether you use the word discussion or negotiation, but the truth of the matter is that matters have been considered, and indeed Brett you have acknowledged, as I have announced some of the issues you have been raising. So I think that’s proof of it. I remember saying at Penrith in relation to the claim about ratios as opposed to nursing hours per patient day…that the former Health Minister, Carmel Tebbutt, who was the Minister when your award was last negotiated, said “we have said all along that a blunt one-size-fits-all ratio will not work in NSW”. She was supporting the idea of nursing hours per patient day which is totally what I support.

Kerry Rodgers:
And as I pointed out to you on that evening, and I point out to you again today, where you denied the fact that ratios exist in NSW – they do in fact. If you would look at Clause 53 of our award, the ratios and nursing hours per patient day can be expressed as an equivalent. I think you are just prevaricating here as you are over the issue of whether it’s a discussion or a negotiation and I’m sorry, but a good faith negotiation does not commence with the government saying “what are you going to give up so that we will give you something else?”.

Minister:
You’re quite right, the award says nursing hours per patient day can be expressed as an equivalent ratio. This was included in the award at the request of the Association in 2010 to provide a comparison only between nursing hours per patient day and the equivalent ratio. The average number of hours can be expressed as an equivalent but it is an average, not a fixed ratio for each shift.

Clare Bolton, John Hunter Hospital branch:
Minister can you explain to the people of NSW why this government places so little value on their regional and rural population that you will not guarantee safe nursing staffing levels in smaller regional and rural hospitals…somebody with a medical condition equivalent to one suffered by somebody in the city, they are not even guaranteed safe staffing levels when they go to some of the smaller facilities such as Byron [Bay], Coffs [Harbour]. And if you go out into the more rural populations, places like Gunnedah and Moree, they don’t have any staffing arrangement at all.

Minister:
As I said, I’ve acknowledged that there is an adequacy in some cases in some of the rural…if you did anything it would be in rural areas. But, can I say I believe that if you are having an operation in a country hospital you will get safe care from your staff, particularly the nursing staff. It doesn’t matter where you are, the nursing staff and others will provide safe care and it’s the flexibility of the arrangements that will provide that. So I’m sorry I just won’t buy that you are not getting a safe service if you go to a country hospital, I just don’t buy it.

Clare Bolton:
If you’re a post-op patient in Scone, you’re on the ward, there are two nurses looking after you. A patient comes into the emergency department and has a cardiac arrest: both of those nurses are needed in that emergency room so there is no nurse looking after the patients on the ward. How can you deem that to be safe?

Minister:
You’ve talked about having procedures; I’m talking about having procedures. I believe that an operation wherever it is you provide the best quality patient care and you can have exactly that same kind of emergency in any hospital and I’ve got great confidence that you will…(interjection from audience)…I’m sorry, we’ll have to agree to disagree on that.

Brian Grant

Brian Grant, Liverpool Hospital branch:
Minister, every day of the week, seven days a week, people turn up in the emergency department drunk, totally intoxicated. I know at Liverpool, because I am one of the cardiac liaison nurses, I go down there regularly, for at least three to four people a day in that emergency department totally intoxicated. In fact, last week, a man turned up in a coronary care unit, stayed for two days…[had to have] defibrillation …because of his intoxication. Now in 36 years at Liverpool Hospital, I have never seen…I’ve seen people drunk and turn up…but never in the numbers like this. Now, the previous government refused to grasp the mettle, your government seems to still not be able to grasp the mettle in controlling the amount of alcohol that is actually dispensed, and I just wonder what is the power of the alcohol lobbyist to lead to this current detrimental…unsafe and dangerous social situation? What have you got to say about that Minister?

Minister:
I share your concern about the number of people turning up at our EDs particularly intoxicated and we’ve done some work in places like Kings Cross where it’s really been a focal point trying to come up with initiatives that can address that. The bottom line is it is about personal responsibility and it’s about family responsibility; …particularly for young people, you’ve got young people waiting until 11 o’clock at night to go out to a party, getting drunk before they go, you have to have a certain level of personal responsibility. I don’t think there’s much you can do by way of regulation that can do as much as can be done by families actually taking responsibility for their own behaviour. Yes, you can have lockouts and that’s been tried in parts…early closures, that’s been tried and certainly that’s something that continues to be looked at as are some of the now sober-up centres that are being implemented. But the reality is we can’t stick everyone who’s drunk in a sober-up centre, we have to try and prevent this kind of behaviour in the first place.